Topical corticosteroids and topical calcineurin inhibitors are the two main approved treatments insofar as evidence-based medicine is concerned. However, some more experimental therapies are out there, such as laser, platelet-rich plasma, and phototherapy. We have discussed ablative and non-ablative lasers, as well as platelet-rich plasma. Today, as part of our experimental treatment series, we will be discussing phototherapy for lichen sclerosus. We will answer questions like what phototherapy is, who performs it, what to expect, and what the science says about it.
Our philosophy here at Lichen Sclerosus Support Network is always to present the evidence and/or what the experts are saying so you can make informed decisions about your body and healthcare plan.
*This post is evidence-based; I draw on the medical literature to share what you need to know about phototherapy for lichen sclerosus. Importantly, what I share is my interpretation of the science and data.
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What Are Experimental Treatments/Therapies?
Experimental therapies show promise in managing a condition but have yet to be thoroughly evaluated for efficacy, safety, and acceptability. Think of it like a non-approved treatment option; it may or may not work. In the context of lichen sclerosus, when discussing experimental treatment options, we mean interventions, medications, or procedures that have not yet been shown to be fully effective as a treatment but show promise in helping with symptom management.
What is Phototherapy for Lichen Sclerosus?
Phototherapy (also known as light therapy) reduces skin cell growth and treats underlying inflammation via ultraviolet light. Phototherapy is used in several skin conditions, including psoriasis, eczema, cutaneous T-cell lymphoma, etc. (American Academy of Dermatology, 2023). Phototherapy, like laser and PRP, is considered experimental therapy because it does not have enough research behind it and has not proven to be an effective treatment for LS. Effective treatments for lichen sclerosus need to demonstrate a statistically significant reduction of inflammation in the biopsies taken before and after administering phototherapy.
Who Performs Phototherapy
Some, but not all, dermatologists can perform this procedure in the office. If you want to try phototherapy:
- Chat with your dermatologist to see if they offer it.
- If your dermatologist does not offer this, ask if they can refer you to an office that does.
- Be mindful that this procedure is usually performed on the non-genital skin of the body. Therefore, not all practitioners will feel comfortable using it on the genitals.
Before getting phototherapy, your dermatologist will assess your skin and medical history to determine if you are a good candidate. Be sure to tell your doctors about any medications and supplements you are taking, such as retinoids and antibiotics, because they can make your skin more sensitive to ultraviolet light from phototherapy 1. Even if you think it’s inconsequential, tell them anyway. For example, I would tell them I take Cipralex for anxiety, magnesium, and melatonin for sleep. I share this in case those medications/supplements could cause problems.
What About Hand-Held Devices?
Some studies provided hand-held devices for patients to bring home and use. However, many of the hand-held devices you find online are not well-studied and do not have data on genital use. For your safety, we recommend getting approval from your healthcare provider before using this on your genitals. Show them the model first so they can properly investigate the safety profile of using them on the genitals before you purchase.
What to Expect
Phototherapy can leave the skin red, itchy, and dried out. It is important to apply a barrier cream such as Vaseline or Aquaphor afterward to help the skin from drying out 2. If you experience pain, discussing this with your healthcare provider is essential.
Is Phototherapy Effective for Lichen Sclerosus?
While there is some evidence that phototherapy may be beneficial for extragenital lichen sclerosus (i.e., lichen sclerosus that affects the rest of the body, like chest, abdomen, and thighs), it is unclear whether it would be beneficial (and safe) for the genital skin 3.
But what about studies on vulvar lichen sclerosus? Do those show any promise?
Phototherapy for vulvar lichen sclerosus does not have a lot of research behind it. Other treatments like steroids have a lot more research behind them. However, I did find one good study looking at phototherapy for lichen sclerosus.
In 2014, Terras et al. conducted a randomized study comparing the efficacy of phototherapy versus clobetasol for vulvar lichen sclerosus. The study took 30 patients and randomized them into two groups: the phototherapy and clobetasol groups.
The findings showed that while the phototherapy group found some relief of symptoms (but not all), the clobetasol group outperformed phototherapy regarding symptom relief and showed a significant reduction of inflammation from pre and post-biopsy samples.
That is, the phototherapy group did not show a significant reduction in inflammation.
The authors conclude that while there are benefits to phototherapy for vulvar lichen sclerosus, it is not nearly as effective overall as clobetasol. These studies show that ultrapotent topical corticosteroids should still be considered the gold standard and first line of treatment, with phototherapy as a potential adjunct therapy. However, more research is needed on the risks and benefits of phototherapy. We also need research comparing different devices.
Conclusion on Phototherapy and Lichen Sclerosus
In sum, phototherapy is not yet considered a treatment option for lichen sclerosus as it has not been proven to reduce inflammation. However, there is still a lot of research that needs to be done in this area. In particular, it would be interesting to have RCTs and studies that look at different phototherapy devices, as some may work better than others. Some researchers note that while it should not be a first-line treatment, it could be added to your primary treatment as an adjunct. As always, discuss the risks versus benefits of including this in your LS care routine with your healthcare provider.
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Sources Cited & Referenced
- Memorial Sloan Kettering Cancer Center, 2023
- American Academy of Dermatology, 2023
- Kreuter A, Gambichler T, Avermaete A, Happe M, Bacharach-Buhles M, Hoffmann K, Jansen T, Altmeyer P, von Kobyletzki G. Low-dose ultraviolet A1 phototherapy for extragenital lichen sclerosus: results of a preliminary study. J Am Acad Dermatol. 2002 Feb;46(2):251-5. doi: 10.1067/mjd.2002.118552. PMID: 11807437